Ophthalmology and Optometry Coding Alert

Question: My doctor performed a brow ptosis repair, and he wants to report it bilaterally. I thought that Medicare prevented us from doing that. Who's right?

Kansas Subscriber

Answer: Either one of you could be right, depending on when the ophthalmologist performed the surgery. With an implementation date of July 5, Medicare changed the rules for reporting several surgeries bilaterally, including 67900 (Repair of brow ptosis [supraciliary, mid-forehead or coronal approach]). The bilateral indicator for 67900 is changing to "1," which means that a 150 percent fee adjustment will apply to the procedure if you report it bilaterally.
 
This change is retroactive to Jan. 1, 2005. If the surgery occurred on or after Jan. 1, 2005, you can code 67900 bilaterally. If it occurred in 2004, the old rules still apply and you will see no fee adjustment for the bilateral service.
 
Note: For more information about this change, see "News You Can Use: Earn 150 Percent of RVUs for Most Eyelid Surgery" in the June 2005 Ophthalmology Coding Alert.

 - Advice for You Be the Coder and Reader Questions provided by Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates, Clearwater, Fla; and Raequell Duran, president of Practice Solutions, Santa Barbara, Calif.